Individual
JOHN DOMINIC DECARLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
16650 W BLUEMOUND RD # 400B, BROOKFIELD, WI 53005-5920
(414) 476-5120
(414) 476-5181
Mailing address
16650 W BLUEMOUND RD # 400B, BROOKFIELD, WI 53005-5920
(414) 476-5120
(414) 476-5181
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
21652-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30261600
—
WI
01
—
391382883015
BLUE CROSS BLUE SHIELD
WI
Enumeration date
04/13/2006
Last updated
02/19/2024
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